Other ECP Providers (defined to include Substance Use Disorder Treatment Centers, Community Mental Health Centers, Rural Health Clinics, Black Lung Clinics, Hemophilia Treatment Centers, Sexually Transmitted Disease Clinics, and Tuberculosis Clinics).<\/li>\n<\/ul>\nIn the 2024 NBPP, HHS is proposing two modifications to its ECP standards. First, it would create two new and distinct ECP categories: Mental Health Facilities and Substance Use Disorder (SUD) Treatment Centers. These providers would thus be removed from the \u201cOther ECP Providers\u201d category. Creating these two new categories would require issuers to attempt to contract with at least one SUD Treatment Center and at least one Mental Health Facility. HHS would also add Rural Emergency Hospitals as a provider type in the \u201cOther ECP Providers\u201d category.<\/p>\n
Second, HHS is proposing to require QHPs to contract with at least 35 percent of available FQHCs and at least 35 percent of available Family Planning Providers that qualify as ECPs within the plan\u2019s service area. This would be in addition to the existing requirement that plans have at least 35% of all available ECPs within their service area, in-network. For 2024, HHS is focusing on FQHCs and Family Planning Providers because these are the largest categories of providers (representing approximately 62% of all facilities on the ECP list). However, the agency is considering adding a specified minimum threshold to other ECP categories in the future. HHS does not believe this requirement would be difficult for QHP issuers to meet, noting that of 2023 QHP issuers, 75% would already meet or exceed the 35% threshold for FQHCs and 61% would meet the threshold for Family Planning providers.<\/p>\n
Prohibiting Mid-Year Terminations For Dependent Children Who Reach Maximum Age<\/h2>\n
The ACA requires group health plans and insurance issuers that offer coverage to dependent children to allow those children to stay on their parents\u2019 plan until age 26. Operationally, HealthCare.gov requires issuers that cover dependent children to maintain that coverage until the end of the plan year in which they turn 26. In this proposed rule, HHS would codify this requirement in regulation to provide more clarity for participating issuers and reduce enrollee uncertainty about their coverage. This requirement would apply to plans offered through the FFM and SBM-FPs. SBMs could implement a similar rule at their option. The agency notes that, with respect to families that receive APTCs, the marketplace makes eligibility determinations for the entire plan year. The marketplace will continue to pay APTCs to the issuer, including the portion attributable to a dependent child, through the end of the plan year in which the dependent child turns 26. If otherwise eligible, the family member that has turned 26 will be re-enrolled into a separate policy beginning January 1 of the following plan year, with any APTCs for which they are eligible.<\/p>\n
Establishing A Timeliness Standard For Notices Of Payment Delinquency<\/h2>\n
When a plan enrollee becomes delinquent in making premium payments, HHS requires insurers to send a notice to the enrollee so they have an opportunity to pay unpaid premiums and avoid a termination of their coverage. In conducting oversight of issuers, the agency found that some were delaying sending these notices, in extreme cases preventing the enrollee from correcting their delinquency. HHS is thus proposing establishing a timeliness standard for these notices and asks for comment on what a reasonable timeframe would be.<\/p>\n
Standards For Navigators And Other Consumer Assisters<\/h2>\nAllowing Door-To-Door Assistance<\/h3>\n
Federal rules currently prohibit Navigators, certified application counselors, and non-Navigator assistance providers (\u201cAssisters\u201d) from going door-to-door or using unsolicited means to provide enrollment assistance to consumers. HHS is proposing to repeal that prohibition. The agency notes that it has established safeguards to ensure that Assisters are maintaining the privacy and security of consumers\u2019 information. It also argues that prohibiting Assisters from going door-to-door creates barriers for consumers who must make appointments to obtain enrollment help and imposes undue burdens on individuals whose travel is limited by lack of mobility or affordable transportation, or who are immunocompromised.<\/p>\n
Rules For Brokers And Agents<\/h3>\n
The proposed rule would establish new requirements for agents, brokers, and web-brokers that assist consumers with FFM and SBM-FP enrollments. Existing federal rules enable HHS to suspend marketplace agreements with brokers and agents for up to 90 days, when there is evidence of fraud or abusive conduct. In cases of severe misconduct, HHS can terminate the agent or broker\u2019s agreement with the marketplace. In both cases, agents and brokers can try to rebut the charges against them and restore their ability to facilitate enrollments.<\/p>\n
Noting that the process for reviewing agent and broker rebuttal materials is time intensive and often requires review of complex technical information and data, HHS is proposing to extend the timeframe for review. Specifically, HHS is proposing to give itself up to 45 days to review rebuttal evidence from brokers and agents who have had their marketplace agreements suspended, and up to 60 days to review submissions from agents and brokers that have had their marketplace agreements terminated.<\/p>\n
The proposed rule would also require agents, brokers, and web-brokers to document that their clients (or authorized representatives) have reviewed and confirmed their eligibility information before they submit an application. The documentation would need to include the date the consumer reviewed the application, the consumer\u2019s name (or authorized representative\u2019s name), an explanation of the attestations in the application, and the name of the agent, broker, or web-broker providing the assistance. Brokers and agents would need to maintain this documentation for at least 10 years and be able to provide it to HHS upon request.<\/p>\n
HHS observes that it has received consumer complaints about agents, brokers, or web-brokers submitting incorrect application information on their behalf. The agency notes that these complaints are difficult to investigate because they often involve one person\u2019s word against another\u2019s. HHS believes that requiring documentation that the consumer has reviewed and confirmed their application information could help with the adjudication and resolution of such complaints. Although HHS would not prescribe exactly how agents, brokers, and web-brokers should obtain the required documentation, they would provide a non-exhaustive list of acceptable methods. The agency seeks comment on this proposal, including information on current best practices among the agent\/broker community.<\/p>\n
The proposed rule would also require FFM and SBM-FP agents, brokers, and web-brokers to document that they have received a consumer\u2019s consent to assist them with a marketplace eligibility application. This consent would need to include the date, the consumer\u2019s name (or authorized representative), and the name of the agent, broker, or web-broker. While the agency declines to prescribe the form of consent, they note that it could take the form of a signature or a recorded verbal authorization. The broker, agent, or web-broker would be required to maintain a record of the consent for at least 10 years and be able to produce it for HHS upon request. The agency notes that they have received consumer complaints alleging that they were enrolled in marketplace coverage without consent. When investigating these complaints, HHS has found agents and brokers who attest to receiving consent but cannot produce reliable records to defend themselves from the allegations.<\/p>\n
Author\u2019s Note<\/h3>\n
The Robert Wood Johnson Foundation provided grant support for the author’s time researching and writing this post.<\/p>\n
Sabrina Corlette, “Proposed 2024 Payment Rule, Part I: Insurance Market Reforms and Consumer Assistance,” Health Affairs Forefront, December 14, 2022,\u00a0https:\/\/www.healthaffairs.org\/content\/forefront\/proposed-2024-payment-rule-part-1-insurance-market-reforms-consumer-assistance-and-risk\u00a0\u00a9 2022 Health Affairs by Project HOPE \u2013 The People-to-People Health Foundation, Inc.<\/p>\n","protected":false},"excerpt":{"rendered":"
In its 2024 Notice of Benefit & Payment Parameters, the Biden administration has proposed a number of policy changes and operational updates for the Affordable Care Act’s marketplaces and consumer protections. CHIR’s Sabrina Corlette provides a deep dive on the proposals in Health Affairs’ Forefront.<\/p>\n","protected":false},"author":2,"featured_media":4010,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/7038"}],"collection":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/comments?post=7038"}],"version-history":[{"count":5,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/7038\/revisions"}],"predecessor-version":[{"id":7043,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/7038\/revisions\/7043"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/media\/4010"}],"wp:attachment":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/media?parent=7038"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/categories?post=7038"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/tags?post=7038"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}